Provider Demographics
NPI:1497968333
Name:SHAMMOUT, BILAL (DDS)
Entity Type:Individual
Prefix:
First Name:BILAL
Middle Name:
Last Name:SHAMMOUT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44215 15TH ST W
Mailing Address - Street 2:UNIT 313
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44215 15TH ST W
Practice Address - Street 2:UNIT 313
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4014
Practice Address - Country:US
Practice Address - Phone:661-948-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL178881223E0200X
WA000106851223E0200X
CA603281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics